Job description

• Facilitates complex projects and functions of high importance as an independent project lead. • Plans and manages the project development process and oversees implementation. • Analyzes intricate project objectives, data sources, methodology, data summaries and findings, and prepares and edits draft, revised and final reports for dissemination to key project sponsors to meet information request specifications. • Coordinates and prioritizes activities with internal and external staff for implementation and monitors work for accuracy. Ensures that outcomes meet HMSA's corporate goals. • Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting terms and the influence they may have on overall program/plan cost and utilization. • Analyze data and identify trends, patterns, or other notable issues with an eye for cost reduction opportunities. • Monitor market trends to identify emerging opportunities or risks in business environments. • Monitor various websites for reimbursement and policy changes, focusing on Government entities; make recommendations for implementation of changes. • Communicate with various stakeholders, including physicians, hospital admin staff, other healthcare insurers, auditors, and other departments within the company. • Annual review of compliance workflows, such as, SSAE, MAR. • Independently participate in current audits; be able to respond comprehensively to auditor inquiries. • Review provider contracts and ensure that claims system set ups accurately reflect fully executed, signed agreements. • Mentors team members; provides feedback and direction on staff's work. • Performs all other miscellaneous responsibilities and duties as assigned or directed • Serve as a team player and role model for other employees in the organization by always exhibiting traits of courtesy, caring, helpfulness, and respect; conducts oneself in a service-oriented manner that is attentive, pleasant, cooperative, sensitive, respectful, and kind when dealing with members, visitors, the public, and all employees. #LI-Hybrid • Bachelor's degree and five years of related work experience; or equivalent combination of education and experience. • Proficiency in Data reporting and analysis • Demonstrated working knowledge of managed care/health care business processes, systems and application for claims payment, network, and provider contract administration. • Proficiency in project management skills • Intermediate working knowledge of Microsoft Office applications, including, but not limited to Word, PowerPoint, and Outlook. • Advanced working knowledge of Microsoft Excel. • Advanced working knowledge of MicroStrategy, SQL, SAS, or other query language.

Requirements

Must-haves

Facilitates complex projects and functions of high importance as an independent project lead.
Plans and manages the project development process and oversees implementation.
Coordinates and prioritizes activities with internal and external staff for implementation and monitors work for accuracy. Ensures that outcomes meet HMSA's corporate goals.
Analyze data and identify trends, patterns, or other notable issues with an eye for cost reduction opportunities.
Monitor market trends to identify emerging opportunities or risks in business environments.
Monitor various websites for reimbursement and policy changes, focusing on Government entities; make recommendations for implementation of changes.
Communicate with various stakeholders, including physicians, hospital admin staff, other healthcare insurers, auditors, and other departments within the company.
Annual review of compliance workflows, such as, SSAE, MAR.
Independently participate in current audits; be able to respond comprehensively to auditor inquiries.
Review provider contracts and ensure that claims system set ups accurately reflect fully executed, signed agreements.
Mentors team members; provides feedback and direction on staff's work.
Performs all other miscellaneous responsibilities and duties as assigned or directed
Bachelor's degree and five years of related work experience; or equivalent combination of education and experience.
Proficiency in Data reporting and analysis
Proficiency in project management skills
Intermediate working knowledge of Microsoft Office applications, including, but not limited to Word, PowerPoint, and Outlook.
Advanced working knowledge of Microsoft Excel.
Advanced working knowledge of MicroStrategy, SQL, SAS, or other query language.

Nice-to-haves

None flagged.

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

sql

Platform: adp-recruiting
Effort: medium